Correlation between elevated serum progesterone in the day of hcg injection, metaphase ii oocytes and their impact on the success of icsi

Abstract

Objective: In this study we tried to understand the effect of progesterone level at the time of ovulation trigger on intracytoplasmic sperm injection (ICSI) outcome. We expected identifying cut off values for serum progesterone level the day of hCG injection (P-hCG) & P-hCG per mature oocyte ratio (P-hCG / MII), as predictive tests of ICSI success. Methods: 200 women 18-40 years old and attending IVF unit of Kasr el Aini hospital for management of infertility were included in the study. They were scheduled for ICSI after controlled ovarian induction with GnRH-agonist protocol. Inclusion criteria were tubal factor of infertility, unexplained infertility, polycystic ovarian syndrome and BMI ≤ 30 kg/m2. Exclusion criteria were severe male factor infertility, hyperprolactinemic patients, high basal FSH > 11 IU/L, frozen embryo transfer cycles, uterine anomalies or synechia. Primary outcome parameter included correlation of serum progesterone on day HCG administration, number of MII oocytes and calculated progesterone/ MII oocyte ratio with success of ICSI. Results: 193cases underwent embryo transfer, 7cases cancelled. Clinical pregnancy was reported in 52 (27.9%) cases. Higher P-hCG was observed in cases who didn’t get pregnant compared to those who got pregnant (p= 0.01) with cut off value of 1 ng/ml correlated well with the clinical pregnancy rate after ICSI with 61% sensitivity and 59% specificity (p=0.004). A significantly lower P-hCG/MII ratio was found in the pregnant women group compared to that found in the non-pregnant group (p=0.001) and cut off value of 0.18 correlated best with clinical pregnancy after ICSI with sensitivity 70.5% and specificity 61.2% (p<0.001). Conclusion: We demonstrated negative correlation between P-hCG and P-hCG/MII and clinical pregnancy rate after ICSI.